Cardiovascular disease

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**Cardiovascular disease**
*Classifications and external resources*
ICD-10	I00-I78
ICD-9	390-434, 436-448

Cardiovascular disease refers to the class of diseases that involve the heart and/or blood vessels (arteries and veins). While the term technically refers to any disease that affects the cardiovascular system, it is usually used to refer to those related to atherosclerosis (arterial disease). These conditions have similar causes, mechanisms, and treatments. In practice, cardiovascular disease is treated by cardiologists, thoracic surgeons, vascular surgeons, neurologists, and interventional radiologists, depending on the organ system that is being treated. There is considerable overlap in the specialties, and it is common for certain procedures to be performed by different types of specialists in the same hospital.

Over 71.3 million Americans have cardiovascular problems^{[citation needed]}, and most other Western countries face high and increasing rates of cardiovascular disease. It is the number 1 cause of death and disability in the United States and most European countries. By the time that heart problems are detected, the underlying cause (atherosclerosis) is usually quite advanced, having progressed for decades. There is therefore increased emphasis on preventing atherosclerosis by modifying risk factors, such as healthy eating, exercise and avoidance of smoking.

1 Risk factors
2 Prevention
3 Treatment
4 Research
5 References
6 External links

[edit] Risk factors

There are many risk factors which predispose to various forms of cardiovascular disease. These include the following:

Age
Absence of key nutritional elements, such as polyphenol antioxidants
Diabetes mellitus
Hypercholesterolemia (elevated cholesterol levels) and abnormal lipoprotein particle profile (cholesterol subtypes)
Tobacco smoking
Higher fibrinogen and PAI-1 blood concentrations
Elevated homocysteine, or even upper half of normal
Elevated blood levels of asymmetric dimethylarginine
High blood pressure
Exposure to high levels of environmental noise
Obesity, especially central or male-type obesity; apart from being linked to diabetes, this form of obesity independently increases cardiovascular risk, presumedly by inducing an inflammatory and procoagulant state
Genetic factors/Family history of cardiovascular disease
Physical inactivity/ Sedentary lifestyle
Depression
Stress

Although men have a higher rate of cardiovascular disease than women, it is also the number one health problem for women in industrialized countries. After menopause, the risk for women approaches that of men. Hormone replacement therapy alleviates a number of post-menopausal problems, but appears to increase the risk of cardiovascular disease.

[edit] Prevention

Attempts to prevent cardiovascular disease take the form of modifying risk factors. Some, such as sex (male or female), age, and family history, cannot be modified. Smoking cessation (or abstinence) is one of the most effective and easily modifiable changes. Regular cardiovascular exercise (aerobic exercise) complements the healthful eating habits. Sometimes, the combination of diet and exercise will improve lipoprotein (cholesterol) levels; if not, a physician may prescribe "cholesterol-lowering" drugs, such as the statins. These medications have additional protective benefits aside from their lipoprotein profile improvement. Aspirin may also be prescribed, as it has been shown to decrease the clot formation that may lead to myocardial infarctions and strokes; it is routinely prescribed for patients with one or more cardiovascular risk factors.

One little known or discussed, but powerful way to almost eliminate risk of cardiovascular disease is keep your total cholesterol below 150. In the Framingham Heart Study, those with total cholesterol below 150 only very rarely got coronary heart disease. (see external link below)

Eating oily fish at least twice a week may help reduce the risk of sudden death and arrhythmias. Olive oil is said to have the greatest benefits. Studies of individual heart cells showed that the fatty acids blocked excessive sodium and calcium currents in the heart, which could otherwise cause dangerous, unpredictable changes in its rhythm (Leaf et al 2003).

[edit] Treatment

Treatment of cardiovascular disease depends on the specific form of the disease in each patient, but effective treatment always includes preventive lifestyle changes discussed above. Medications, such as blood pressure reducing medications, aspirin and the statin cholesterol-lowering drugs may be helpful. In some circumstances, surgery or angioplasty may be warranted to reopen, repair, or replace damaged blood vessels.

[edit] Research

The causes, prevention, and/or treatment of all forms of cardiovascular disease are active fields of biomedical research, with hundreds of scientific studies being published on a weekly basis.

A fairly recent emphasis is on the link between low-grade inflammation that hallmarks atherosclerosis and its possible interventions. C-reactive protein (CRP) is an inflammatory marker that may be present in increased levels in the blood in patients at risk for cardiovascular disease. Its exact role in predicting disease is the subject of debate.

Some areas currently being researched include possible links between infection with Chlamydia pneumoniae and coronary artery disease. The Chlamydia link has become less plausible with the absence of improvement after antibiotic use (Andraws et al 2005).

[edit] References

Andraws R, Berger JS, Brown DL. Effects of antibiotic therapy on outcomes of patients with coronary artery disease. JAMA 2005;293:2641-7. PMID 15928286.
Leaf A, Kang JX, Xiao YF, Billman GE. Clinical prevention of sudden cardiac death by n-3 polyunsaturated fatty acids and mechanism of prevention of arrhythmias by n-3 fish oils. Circulation 2003;107:2646-52. PMID 12782616.
American Heart Association "Heart Disease and Stroke Statistics-2006 Update". http://www.americanheart.org/downloadable/heart/1140534985281Statsupdate06book.pdf